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We consulted master billing expert Sam Collins for his thoughts.
The Issue:
Insurance carriers claim they will not pay for neuro-muscular re-education [NMR] since there is "no serious brain or nerve injury".
The Answer:
Collins reports 97112 is a "trick service". 97112 is intended to 'restore balance, coordination, muscular weakness as a result of cerebral dysfunction'.
97112 there must be a demonstrated loss of one of these symptoms. This code often confuses many providers who assume the simple use of the balance ball, etc., makes the exercise NMR, 97112 should be appropriate. Collins says that 97110 is more appropriate as the goal is more about specific strength, flexibility and endurance and not as much balance and coordination.
Note that 97112 and 97110 have the same value.
Collins recommends using the 97110 for sprains and strains. Otherwise, 97112 is usually justified to make the NMR intended for patients with significant neuro loss such as stroke, etc.
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